Healthcare Provider Details

I. General information

NPI: 1699100651
Provider Name (Legal Business Name): MITZI D CLARK DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N CAMPUS
ITHACA NY
14853-6007
US

IV. Provider business mailing address

4434 FRONTIER TRL
AUSTIN TX
78745-1514
US

V. Phone/Fax

Practice location:
  • Phone: 607-253-3060
  • Fax:
Mailing address:
  • Phone: 512-892-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number015483-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: